Epidemiology of severely injuried foot

Abstract

Objective: To assess epidemiological data and management of the severely injured foot. Methods: The medical records of patients with severe foot and ankle injuries from January, 1985 to July, 2007 were systematically reviewed. Results: Seventy-six patients (82 feet) were included in the current study, 61 males and 15 females, with a mean age of 31 years. The mechanisms of trauma were: 34% fall from height, 22% hit by a car, 17% MVA, 17% motorcycle accident, and 10% caused by crushing by a heavy object. Fourteen patients were victims of multiple traumas and thirty suffered fractures affecting other regions of the body, beyond the foot and distal end of the leg. Open fractures occurred in 62%, grade III in 80%. Serious ligament damage occurred in 59%, mainly in the tarsal-metatarsal (Lisfranc) joint. Compartment syndrome of the foot was diagnosed and treated with an emergency fasciotomy in 35 extremities. Additional skin coverage was necessary in 20 feet. For the definitive treatment external fixation was used in nine of 82 extremities, internal fixation in 48, and combined internal and external fixation in 14 extremities. Primary arthrodesis was performed in 10 extremities (12%). Early amputation was performed on 13 of 82 severely traumatized extremities. Conclusion: The severely injured foot poses a great management challenge and should be considered as a unique entity, mostly due to soft tissue injuries and multiple associated fractures. Special attention should be given to compartment decompression of the foot and primary arthrodesis of the joints that cannot be repaired. Moreover, the surgeon should consider and discuss with patients primary amputation as a treatment.